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Neuroleptic Malignant Syndrome: Title and subTitle BreakSuccessful Treatment With Bromocriptine FREE

Peter S. Mueller, MD; John W. Vester, MD; Joseph Fermaglich, MD
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JAMA. 1983;249(3):386-388. doi:10.1001/jama.1983.03330270050032
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THE NEUROLEPTIC malignant syndrome (NMS) is characterized by severe extrapyramidal dysfunction, hyperthermia, and autonomic disturbances following neuroleptic usage.1,2 This relatively uncommon, potentially lethal syndrome carries a mortality of 20%, yet it is largely unrecognized by physicians and most workers engaged in the neurosciences. Anticholinergic or benzodiazepine treatment, commonly used for neuroleptic neurological side effects, is usually of limited success in the treatment of NMS; a long hospital course with considerable physical disability often is a result in those patients who survive.3 We present two patients with NMS: the first treated in the usual fashion in our medical intensive care unit (ICU), the second on our psychiatric ward, with the rapidly successful and first reported usage of bromocriptine mesylate.

Report of Cases 

Case 1.—  A 28-year-old married woman had been well until Feb 2, 1977, when an acute schizophrenic psychosis with paranoia and catatonia rapidly developed. During her first

REFERENCES

Delay J, Deniker P:  Drug-induced extrapyramidal syndromes , in Vinker PJ, Bruyn GW (eds): Handbook of Clinical Neurology: Diseases of the Basal Ganglia . Amsterdam, North Holland Publishing Co, 1968;, pp 248-266.
Caroff SN:  The neuroleptic malignant syndrome . J Clin Psychiatry 1980;;41:79-83.
Smego RA, Durack DT:  The neuroleptic malignant syndrome . Arch Intern Med 1982;; 142:1183-1185.
Bergman JA:  Idiopathic malignant hyperthermia . Arch Ophthalmol 1975;;93:232-234.
Coons DJ, Hillman FJ, Marshall RW:  Treatment of neuroleptic malignant syndrome with dantrolene sodium: A case report . Am J Psychiatry 1982;;139:944-945.
Cohen WJ, Cohen NH:  Lithium carbonate, haloperidol, and irreversible brain damage . JAMA 1974;;230:1283-1287.
Geller B, Greydanus DE:  Haloperidolinduced comatose state with hyperthermia and rigidity in adolescence: Two case reports with a literature review . J Clin Psychiatry 1979;;40:102-103.
Burke RE, Fahn S, Mayeux R, et al:  Neuroleptic malignant syndrome caused by dopamine depleting drugs in a patient with Huntington disease . Neurology 1981;;31:1022-1026.
Toru M, Matsuda 0, Makiguch K, et al:  Neuroleptic malignant syndrome-like state following a withdrawal of antiparkinsonian drugs . J Nerv Ment Dis 1981;;169:324-327.
Henderson VW, Wooten GF:  Neuroleptic malignant syndrome: A pathogenic role for dopamine receptor blockade? Neurology 1981;; 31:132-137.
Anderson BG, Reker D, Cooper TB:  Prolonged adverse effects of haloperidol in normal subjects . N Engl J Med 1981;;305:643-644.
Reid JL:  Dopamine supersensitivity in the hypothalamus? Adv Neurol 1975;;9:73-80.
Meltzer HY:  Rigidity, hyperpyrexia and coma following fluphenazine enanthate . Psychopharmacologia 1973;;29:337-346.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Delay J, Deniker P:  Drug-induced extrapyramidal syndromes , in Vinker PJ, Bruyn GW (eds): Handbook of Clinical Neurology: Diseases of the Basal Ganglia . Amsterdam, North Holland Publishing Co, 1968;, pp 248-266.
Caroff SN:  The neuroleptic malignant syndrome . J Clin Psychiatry 1980;;41:79-83.
Smego RA, Durack DT:  The neuroleptic malignant syndrome . Arch Intern Med 1982;; 142:1183-1185.
Bergman JA:  Idiopathic malignant hyperthermia . Arch Ophthalmol 1975;;93:232-234.
Coons DJ, Hillman FJ, Marshall RW:  Treatment of neuroleptic malignant syndrome with dantrolene sodium: A case report . Am J Psychiatry 1982;;139:944-945.
Cohen WJ, Cohen NH:  Lithium carbonate, haloperidol, and irreversible brain damage . JAMA 1974;;230:1283-1287.
Geller B, Greydanus DE:  Haloperidolinduced comatose state with hyperthermia and rigidity in adolescence: Two case reports with a literature review . J Clin Psychiatry 1979;;40:102-103.
Burke RE, Fahn S, Mayeux R, et al:  Neuroleptic malignant syndrome caused by dopamine depleting drugs in a patient with Huntington disease . Neurology 1981;;31:1022-1026.
Toru M, Matsuda 0, Makiguch K, et al:  Neuroleptic malignant syndrome-like state following a withdrawal of antiparkinsonian drugs . J Nerv Ment Dis 1981;;169:324-327.
Henderson VW, Wooten GF:  Neuroleptic malignant syndrome: A pathogenic role for dopamine receptor blockade? Neurology 1981;; 31:132-137.
Anderson BG, Reker D, Cooper TB:  Prolonged adverse effects of haloperidol in normal subjects . N Engl J Med 1981;;305:643-644.
Reid JL:  Dopamine supersensitivity in the hypothalamus? Adv Neurol 1975;;9:73-80.
Meltzer HY:  Rigidity, hyperpyrexia and coma following fluphenazine enanthate . Psychopharmacologia 1973;;29:337-346.
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